Extracorporeal Membrane Oxygenation Cannulation Timing in the Pediatric Myocarditis Population: An Exploratory Analysis From the Extracorporeal Life Support Organization Registry.

Children presenting with acute myocarditis may experience rapid clinical deterioration requiring extracorporeal membrane oxygenation (ECMO); however, our understanding of best practices and timing of ECMO initiation are lacking. We explored the relationships between pre-cannulation factors and survival in this high-acuity patient population. DESIGN: Retrospective review of a large international registry. Primary outcome was survival to hospital discharge, stratified by incident cardiac arrest (CA) prior to ECMO and time to cannulation after intubation. SETTING AND SUBJECTS: The Extracorporeal Life Support Organization registry was queried for patients less than or equal to 18 years old receiving ECMO support for myocarditis between 2007 and 2018. Exclusion criteria included being nonindex runs, non-venoarterial ECMO or missing data points for main variables studied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Population characteristics and survival were compared using t test, Wilcoxon rank-sum test, or Fisher exact test. Multivariable logistic regression was used for significant factors in the unadjusted logistic regression. Among 506 index ECMO runs in pediatric patients with myocarditis, survival for the cohort was 72%, with no difference between early and late eras (2007-2012 vs 2013-2018; p = 0.69). Survivors demonstrated higher pre-ECMO pH levels as well as shorter intubation-to-cannulation (ITC) times (3 hr [interquartile range (IQR)], 1-14 hr vs 6 hr [IQR, 2-20 hr]; p = 0.021). CA occurred within 24 hours prior to ECMO cannulation, including extracorporeal cardiopulmonary resuscitation, in 54% of ECMO runs (n = 273). Accounting for the interaction between pre-ECMO CA occurrence and ITC time, longer ITC time remained associated with lower survival for patients who did not experience a CA prior to ECMO, with adjusted odds ratio of 0.09 (IQR, 0.02-0.40; p = 0.002) for ITC time greater than or equal to 18 hours. CONCLUSIONS: The results of this multicenter analysis of ECMO utilization and outcomes for pediatric myocarditis suggest that patients approaching ECMO cannulation who have not experienced CA may have better survival outcomes if cannulated onto ECMO early after intubation.

Serum anti-neural immunoreactivity in patients with fibromyalgia. Preliminary study.

INTRODUCTION: Fibromyalgia (FM) is a non-degenerative syndrome characterized by generalized, chronic musculoskeletal pain, as well as mood, memory and sleep disorders. OBJECTIVE: To search for serum anti-neural antibodies (ANeuA) in patients with FM (FMP) in order to rule out autoimmune etiology. METHODS: The Fibromyalgia Impact Questionnaire (FIQ) and Beck's depression inventory (BDI) were applied. Immunoreactivity and the target recognized on the sera from FMPs and healthy subjects were analyzed by indirect immunofluorescence and Western blot. RESULTS: Both FIQ and BDI values were significantly altered in FMPs in comparison with those of controls (FIQ, 70 ± 25 vs. 12 ± 12, p < 0.0001; BDI, 17 ± 11 vs. 4 ± 3, p < 0.0002). Only five out of 15 FMP sera had ANeuA specifically directed against neurons from the medial vestibular nucleus of the brainstem. This immunoreactivity was not detected in the sera from the 14 controls. ANeuA recognized a 45 kDa protein. CONCLUSIONS: 30% of FMPs have ANeuA that have not been described before. In future studies, it will be necessary for anti-neural immunoreactivity to be determined in a larger sample and for the role of ANeuAs in the pathophysiology of FM to be established.

INTRODUCCIÓN: La fibromialgia (FM) es un síndrome no degenerativo caracterizado por dolor musculoesquelético crónico y generalizado; así como por alteraciones anímicas, de memoria y sueño. OBJETIVO: Buscar anticuerpos antineurales (AANeu) séricos en pacientes con FM para descartar etiología autoinmune. MÉTODOS: Se aplicó el Cuestionario de Impacto en Fibromialgia (FIQ) y el Inventario de Depresión de Beck (BDI). La inmunorreactividad y el blanco reconocido por los sueros de pacientes con FM y sujetos sanos se analizó con inmunofluorescencia indirecta y Western blot. RESULTADOS: Los valores de FIQ y BDI estuvieron significativamente alterados en los pacientes con FM, en comparación con los de los controles (FIQ, 70 ± 25 versus 12 ± 12, p < 0.0001; BDI, 17 ± 11 versus 4 ± 3, p < 0.0002). Solo cinco de 15 sueros de pacientes con FM tuvieron AANeu dirigidos específicamente contra las neuronas del núcleo vestibular medio del tronco encefálico; estos no se detectaron en los 14 sueros de los controles. Los AANeu reconocieron una proteína de 45 kDa. CONCLUSIONES: El 30 % de los pacientes con FM tiene AANeu no descritos antes. Será necesario evaluar la inmunorreactividad antineural en una muestra más grande y determinar el papel de los AANeu en la fisiopatología de la FM.

Inmunorreactividad antineural sérica en pacientes con fibromialgia. Estudio preliminar / Serum anti-neural immunoreactivity in patients with fibromyalgia. Preliminary study

Resumen Introducción: La fibromialgia (FM) es un síndrome no degenerativo caracterizado por dolor musculoesquelético crónico y generalizado; así como por alteraciones anímicas, de memoria y sueño. Objetivo: Buscar anticuerpos antineurales (AANeu) séricos en pacientes con FM para descartar etiología autoinmune. Métodos: Se aplicó el Cuestionario de Impacto en Fibromialgia (FIQ) y el Inventario de Depresión de Beck (BDI). La inmunorreactividad y el blanco reconocido por los sueros de pacientes con FM y sujetos sanos se analizó con inmunofluorescencia indirecta y Western blot. Resultados: Los valores de FIQ y BDI estuvieron significativamente alterados en los pacientes con FM, en comparación con los de los controles (FIQ, 70 ± 25 versus 12 ± 12, p < 0.0001; BDI, 17 ± 11 versus 4 ± 3, p < 0.0002). Solo cinco de 15 sueros de pacientes con FM tuvieron AANeu dirigidos específicamente contra las neuronas del núcleo vestibular medio del tronco encefálico; estos no se detectaron en los 14 sueros de los controles. Los AANeu reconocieron una proteína de 45 kDa. Conclusiones: El 30 % de los pacientes con FM tiene AANeu no descritos antes. Será necesario evaluar la inmunorreactividad antineural en una muestra más grande y determinar el papel de los AANeu en la fisiopatología de la FM.

Abstract Introduction: Fibromyalgia (FM) is a non-degenerative syndrome characterized by generalized, chronic musculoskeletal pain, as well as mood, memory and sleep disorders. Objective: To search for serum anti-neural antibodies (ANeuA) in patients with FM (FMP) in order to rule out autoimmune etiology. Methods: The Fibromyalgia Impact Questionnaire (FIQ) and BECK’s depression inventory (BDI) were applied. Immunorreactivity and the target recognized on the sera from FMPs and healthy subjects were analyzed by indirect immunofluorescence and Western blot. Results: Both FIQ and BDI values were significantly altered in FMPs in comparison with those of controls (FIQ, 70 ± 25 vs. 12 ± 12, p < 0.0001; BDI, 17 ± 11 vs. 4 ± 3, p < 0.0002). Only five out of 15 FMP sera had ANeuA specifically directed against neurons from the medial vestibular nucleus of the brainstem. This immunoreactivity was not detected in the sera from the 14 controls. ANeuA recognized a 45 kDa protein. Conclusions: 30% of FMPs have ANeuA that have not been described before. In future studies, it will be necessary for anti-neural immunoreactivity to be determined in a larger sample and for the role of ANeuAs in the pathophysiology of FM to be established.

An analysis of Medtronic MiniMed 670G insulin pump use in clinical practice and the impact on glycemic control, quality of life, and compliance.

AIMS: This study evaluated the use of the Medtronic MiniMed 670G system in adults with type 1 diabetes mellitus from a large endocrinology practice and its impact on glycemic control, quality of life (QoL), compliance and safety. METHODS: 84 participants completed one site visit for data collection. Percentage of time in range (TIR: 70-180 mg/dL), hyperglycemia or time above range (TAB) (>180 mg/dL), hypoglycemia or time below range (TBR) (<70 mg/dL), HbA1c, average blood glucose (ABG), and other metrics were evaluated at the last visit using the system (LVMM) and compared between the last visit on previous insulin therapy (LVPT). RESULTS: The mean percentage of TIR at the LVMM was 74.0 ± 12.1%, with an increase of 27.1% (p < 0.001) in TIR from the LVPT. The mean percentage of TAR was 22.9 ± 11.8% and the mean percentage of TBR was 3.2 ± 5.1%. CONCLUSIONS: The use of the Medtronic MiniMed 670G system in our practice resulted in a TIR above the recommended target with a high degree of treatment satisfaction and compliance in adults with type 1 diabetes. Furthermore, the system may be a reasonable choice for patients struggling with significant amounts of hypoglycemia.

Neurotensin-polyplex-mediated brain-derived neurotrophic factor gene delivery into nigral dopamine neurons prevents nigrostriatal degeneration in a rat model of early Parkinson's disease.

BACKGROUND: The neurotrophin Brain-Derived Neurotrophic Factor (BDNF) influences nigral dopaminergic neurons via autocrine and paracrine mechanisms. The reduction of BDNF expression in Parkinson's disease substantia nigra (SN) might contribute to the death of dopaminergic neurons because inhibiting BDNF expression in the SN causes parkinsonism in the rat. This study aimed to demonstrate that increasing BDNF expression in dopaminergic neurons of rats with one week of 6-hydroxydopamine lesion recovers from parkinsonism. The plasmids phDAT-BDNF-flag and phDAT-EGFP, coding for enhanced green fluorescent protein, were transfected using neurotensin (NTS)-polyplex, which enables delivery of genes into the dopaminergic neurons via neurotensin-receptor type 1 (NTSR1) internalization. RESULTS: Two weeks after transfections, RT-PCR and immunofluorescence techniques showed that the residual dopaminergic neurons retain NTSR1 expression and susceptibility to be transfected by the NTS-polyplex. phDAT-BDNF-flag transfection did not increase dopaminergic neurons, but caused 7-fold increase in dopamine fibers within the SN and 5-fold increase in innervation and dopamine levels in the striatum. These neurotrophic effects were accompanied by a significant improvement in motor behavior. CONCLUSIONS: NTS-polyplex-mediated BDNF overexpression in dopaminergic neurons has proven to be effective to remit hemiparkinsonism in the rat. This BDNF gene therapy might be helpful in the early stage of Parkinson's disease.

[Social representations of having a boy/girlfriend in adolescents still in school from low, middle and high social strata in Bogotá]. / Representaciones sociales del noviazgo, en adolescentes escolarizados de estratos bajo, medio y alto, en Bogotá

OBJECTIVES: Studying the significance of having a boy/girlfriend by social representations theory. Identifying participants' convergence and difference around a figurative nuclei, focusing on representation by socio-economic strata and gender. METHODS: A qualitative interpretative approach was adopted. Three schools from different socio-economic strata were used for observation, network association, in-depth interviews and group workshops. Intra-strata, intra-gender and participant triangulation allowed convergent and divergent results to be verified. RESULTS: Having a boy/girlfriend (courtship) in all three strata was considered part of adolescents' life projects aimed at becoming independent from the family, successfully obtaining a job and forming a family in future adult life. Thus, having a boy/girlfriend was not a priority and was seen more as an emotional learning experience. Sexuality was seen as something to be postponed due to the risks of pregnancy. Differences by strata focused on economic obstacles to or chances for achieving goals. Gender differences were found between low and high strata. Girls having low economic status were more conservative, resented greater social control and their loss of independence compared to girls from high socioeconomic strata who demanded their independence and criticised traditional models. Boys having low economic status were more traditional than their upper strata counterparts and the suffering involved in having a girlfriend was linked to infidelity. Suffering in having a boy/girlfriend was linked to such relationship breaking up for upper and middle strata. Masculinity regarding having a boy/girlfriend was affirmed in all strata. DISCUSSION: Emphasis should be placed on designing social policies helping these young people to achieve their future goals, especially teenagers from lower socioeconomic strata who face economic, social and cultural disadvantages.

Representaciones sociales del noviazgo, en adolescentes escolarizados de estratos bajo, medio y alto, en Bogotá / Social representations of having a boy/girlfriend in adolescents still in school from low, middle and high social strata in Bogotá

Objetivos Abordar el significado del noviazgo mediante la teoría de las representaciones sociales. Determinar las convergencias y divergencias de los participantes en torno a los núcleos figurativos de la representación Métodos Aproximación cualitativa interpretativa. En tres colegios diferenciados por estrato, se utilizaron observación, red de asociaciones, entrevista en profundidad y talleres grupales. La triangulación intra estrato, intra género y de totalidad de los participantes, permitió verificar los resultados convergentes y divergentes. Resultados En los tres estratos, el noviazgo hace parte del proyecto de vida centrado en independencia de la familia, éxito laboral y conformación de familia en la vida adulta. El noviazgo no es prioritario y constituye una experiencia de aprendizaje afectivo. La sexualidad coital es concebida como una posibilidad postergable dados los riesgos de embarazo. Las diferencias por estrato, se centraron en los obstáculos o facilidades económicas para realizar las metas. Las diferencias por género se encontraron entre los estratos bajo y alto. Las mujeres de estrato bajo, son más conservadoras, resienten mayor control social y pérdida de independencia. En cambio las del alto, reclaman independencia y critican los modelos tradicionales. Los hombres de estrato bajo, son más tradicionalistas que los de estrato alto y el sufrimiento está ligado a la infidelidad. Discusión Se destaca la responsabilidad en el diseño de políticas sociales que permitan crear y apoyar los caminos que estos jóvenes transiten hacia el logro de sus metas futuras, en especial a los adolescentes del estrato socioeconómico bajo, quienes enfrentan desventajas económicas, sociales y culturales.

Objectives Studying the significance of having a boy/girlfriend by social representations theory. Identifying participants' convergence and difference around a figurative nuclei, focusing on representation by socio-economic strata and gender. Methods A qualitative interpretative approach was adopted. Three schools from different socio-economic strata were used for observation, network association, in-depth interviews and group workshops. Intra-strata, intra-gender and participant triangulation allowed convergent and divergent results to be verified. Results Having a boy/girlfriend (courtship) in all three strata was considered part of adolescents' life projects aimed at becoming independent from the family, successfully obtaining a job and forming a family in future adult life. Thus, having a boy/girlfriend was not a priority and was seen more as an emotional learning experience. Sexuality was seen as something to be postponed due to the risks of pregnancy. Differences by strata focused on economic obstacles to or chances for achieving goals. Gender differences were found between low and high strata. Girls having low economic status were more conservative, resented greater social control and their loss of independence compared to girls from high socioeconomic strata who demanded their independence and criticised traditional models. Boys having low economic status were more traditional than their upper strata counterparts and the suffering involved in having a girlfriend was linked to infidelity. Suffering in having a boy/girlfriend was linked to such relationship breaking up for upper and middle strata. Masculinity regarding having a boy/girlfriend was affirmed in all strata. Discussion Emphasis should be placed on designing social policies helping these young people to achieve their future goals, especially teenagers from lower socioeconomic strata who face economic, social and cultural disadvantages.

Patrones de consumo de alcohol en la población masculina de cuatro consultorios médicos

Se realizó un estudio epidemiológico descriptivo, directo y de corte transversal de la población masculina adulta perteneciente a 4 consultorios médicos de Ciudad de La Habana para realizar una caracterización de ésta según sus patrones de consumo de alcohol. Se encuestó el universo de 910 personas a quienes se aplicaron los cuestionarios CAGE y CID y a un familiar; también se tuvo en cuenta el criterio de la comunidad y la valoración psiquiátrica según la CIE-10. Se detectó el 21,8 % de consumidores de riesgo y el 6,6 % de alcohólicos con un predominio de edades en los grupos de 20 a 29 y de 30 a 39 años de edad respectivamente. Fue alta la ausencia de vínculo laboral en esos grupos. Resultaron significativas las asociaciones entre consumo de alcohol y otros hábitos tóxicos, la repercusión laboral y en las relaciones de pareja.

A cross-sectional, direct, descriptive and epidemiological study of the adult male population from 4 family physician’s offices in Havana City was conducted to characterize it according to its alcohol drinking patterns. 910 persons and a relative of each of them were surveyed by using the CAGE and CID questionnaries. The community’s criterion as well as the psychiatric evaluation according to CIE-10 were taken into account. 21.8 % of risk drinkers and 6.6 % of alcoholics were detected. A predominance was observed in the age groups 20-29 and 30-39, respectively. Most of these persons did not work. The associations between alcohol drinking and other toxic habits, working repercussion and couple’s relations were significant.

Patrones de consumo de alcohol en la población masculina de cuatro consultorios médicos / Alcohol drinking patterns in the male population from four family physician's offices

Se realizó un estudio epidemiológico descriptivo, directo y de corte transversal de la población masculina adulta perteneciente a 4 consultorios médicos de Ciudad de La Habana para realizar una caracterización de ésta según sus patrones de consumo de alcohol. Se encuestó el universo de 910 personas a quienes se aplicaron los cuestionarios CAGE y CID y a un familiar; también se tuvo en cuenta el criterio de la comunidad y la valoración psiquiátrica según la CIE-10. Se detectó el 21,8 porciento de consumidores de riesgo y el 6,6 porciento de alcohólicos con un predominio de edades en los grupos de 20 a 29 y de 30 a 39 años de edad respectivamente. Fue alta la ausencia de vínculo laboral en esos grupos. Resultaron significativas las asociaciones entre consumo de alcohol y otros hábitos tóxicos, la repercusión laboral y en las relaciones de pareja (AU)

Por qué vamos a tener dengue en Orán? / Why go to have dengue in Oran?

Los autores analizan la existencia de condicionantes regionales y sociales favorables al desarrollo del Dengue en la zona de Orán (Salta-Argentina). Proponen un plan de acción tendiente a alentar la participación comunitaria en la prevención de la enfermedad (AU)

Por qué vamos a tener dengue en Orán? / Why go to have dengue in Oran?

Los autores analizan la existencia de condicionantes regionales y sociales favorables al desarrollo del Dengue en la zona de Orán (Salta-Argentina). Proponen un plan de acción tendiente a alentar la participación comunitaria en la prevención de la enfermedad

Dosis util de la yodo-povidona in vitro; estudio experimental / Useful dose of povidone-iodine in vitro; experimental study

Se estudió la máxima dilución útil de yodo-povidona contra diversas especies bacterianas con diluciones en agua destilada de 1/2000 a solución pura (al 10%). Se efectuaron pruebas contra cepas hospitalarias de Escherichia coli, Pseudomona aeruginosa, Klebsiella ozanae, Citrobacter cloacae, Shigella sonnei, Clostridium y un bacilo anaerobio gram negativo no tipificado. Resultaron eficaces las diluciones al 2% ó mayores. No hubo desarrollo en las pruebas con suero humano al 10 y 20% y la dilución al 2,5% del antiséptico. Para comprobar la tolerancia se inyectaron 40 pollos y 7 ratas Wistar a una dosis de 10 cc/Kg de la dilución al 2,5% equivalente a 25 mg/Kg de yodo, con buena tolerancia y sin hallazgos patológicos en las necropsias efectuadas. (AU)

Dosis util de la yodo-povidona in vitro; estudio experimental / Useful dose of povidone-iodine in vitro; experimental study

Se estudió la máxima dilución útil de yodo-povidona contra diversas especies bacterianas con diluciones en agua destilada de 1/2000 a solución pura (al 10%). Se efectuaron pruebas contra cepas hospitalarias de Escherichia coli, Pseudomona aeruginosa, Klebsiella ozanae, Citrobacter cloacae, Shigella sonnei, Clostridium y un bacilo anaerobio gram negativo no tipificado. Resultaron eficaces las diluciones al 2% ó mayores. No hubo desarrollo en las pruebas con suero humano al 10 y 20% y la dilución al 2,5% del antiséptico. Para comprobar la tolerancia se inyectaron 40 pollos y 7 ratas Wistar a una dosis de 10 cc/Kg de la dilución al 2,5% equivalente a 25 mg/Kg de yodo, con buena tolerancia y sin hallazgos patológicos en las necropsias efectuadas.